Task Force endorses limited skin cancer prevention counseling

Abstract

MedWire News: Physicians should counsel individuals aged 10‑24 years about the risk for developing skin cancer as a consequence of sun exposure, whereas older individuals may not benefit from such advice, the US Preventive Services Task Force (USPSTF) suggests.

In its new guidance, the Task Force recognizes that "clinical decisions involve more considerations than evidence alone." It continues: "Clinicians should understand the evidence but individualize decision-making to the specific patient or situation."

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Skin cancer is one of the most common types of cancer, affecting more than 2 million Americans each year. Factors that may raise an individual's risk for developing skin cancer include having light skin, light hair, and light eyes as well as overexposure to ultraviolet (UV) radiation, particularly in early life.

In 2003, recommendations on counseling about skin cancer prevention from the USPSTF applied to individuals of any age. But the current review reveals consistent, significant evidence of a preventive impact of counseling only when given to young people, which the guideline notes is "at the age of greatest vulnerability to UV radiation exposure."

The updated USPSTF guidance is based on new evidence from a targeted search of the literature on the risk for sunburn and skin cancer in association with counseling on sun protection.

Traditional messages about cancer prevention and information about the effect of sun exposure on a person's appearance improved cancer preventive behavior in some people, the paper says.

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For example, one randomized controlled trial of young adults that involved use of a video and in some cases a UV photograph of the face to depict sun damage led to an objective decrease in skin pigmentation over the following year.

In another study, encouraging young adults to read a self-guided booklet about the effects on appearance of sun exposure together with a half-hour discussion with a peer counselor about the impact of sun overexposure reduced the use of indoor sunbeds by up to 35%.

In contrast with the clear benefits of counseling young adults, the USPSTF notes in the latest guidance that "evidence of the effectiveness of counseling interventions in adults older than 24 years or in parents of young children is limited."

One trial found that counseling new parents over four consecutive well-child visits was associated with a significant increase in use of sun protection, whereas improvements in individual measures of protective behavior did not reach statistical significance. The authors say that, "overall, it was difficult to determine the clinical relevance of the small improvements."

Further evidence of the uncertain benefit of counseling in adults was revealed in a series of five intervention studies, four of which found only small improvements in a composite sun-protection score, which again the authors say were of "uncertain clinical significance."